Pharmacists’ roles are changing rapidly and training is struggling to keep pace. As a result, there are plans to roll out a nationwide ‘foundation training’ scheme to equip newly qualified pharmacists with a range of different skills needed across healthcare provision in the UK.
First suggested by the Royal Pharmaceutical Society in 2017 (see Box 1), the plans for a nationwide scheme for all newly trained pharmacists have been dogged by a lack of central funding. However, money is now being put aside to develop a new pathway.
This cannot come quickly enough. ‘Advancing pharmacy education and training: a review’, published by Health Education England (HEE) in June 2019, noted that the country is “experiencing a period of rapid and seismic change in working locations of … pharmacists”, with increasing numbers of people working in general practice, emergency departments, urgent care, nursing homes and residential care homes.
Pharmacists will also be expected to be familiar with advanced technologies, such as advanced therapy medical products and personalised medicine. The HEE report says it is these developments that are “driving the thinking about the need for a new career framework”, which includes a nationwide foundation programme.
Box 1: Timeline
July 2017 — The concept of a UK-wide, mandatory foundation programme first proposed by the Royal Pharmaceutical Society (RPS).
March 2018 — The UK’s four chief pharmaceutical officers write to the RPS endorsing the proposal and asking the faculty and education board’s task and finish group to take the proposal forward.
November 2019 — The framework for the foundation programme is due to be launched.
Latter half of 2020 — The curriculum and assessment processes are expected to be published.
Training for pharmacists
Foundation training is something medics have undertaken for some time. In the UK, for example, doctors begin a two-year foundation programme immediately after graduation and, at the end of that programme, they receive full registration to practice. Dentists must also undertake a one-year foundation programme before they can practice independently in the NHS.
The training is structured to help pharmacists further develop their knowledge, skills and behaviours, as well as gather evidence of their existing skills and competencies. The Royal Pharmaceutical Society’s (RPS’s) foundation programme includes areas such as patient consultations, medicines monitoring, transfer of care, communication skills, working in multidisciplinary teams and clinical governance.
Existing programmes last between 365 days and 1,000 days, and are undertaken in the workplace with support from a tutor. They feature a mix of workplace assessments and portfolio construction, and place emphasis on self assessment and reflection.
Why foundation training is needed
Developments in medicine are advancing at rapidly, as are developments in the technology that healthcare professionals are expected to work wth. An understanding of pharmacogenomics, advanced therapeutic medical products and digital health will be crucial to the pharmacy workforce in the near future. According to the HEE report, this is “driving the thinking about the need for a new career framework”.
In that same report, HEE added that the current variable approach to pharmacist foundation training will not meet demands for a “sustainable clinical pharmacy workforce” that is ready to meet the challenges of dealing with complex conditions across multiple settings.
In its June 2019 report, HEE estimated that about a third of newly registered pharmacists in England are undertaking some form of foundation training.
The RPS has been running a foundation programme since 2014. Open to Society members from all pharmacy sectors, the programme covers the first 1,000 days of practice. Rowlands Pharmacy and Boots are accredited RPS foundation training providers, meaning that their training programmes have been recognised as meeting the highest standards, in line with the Society’s foundation pharmacy framework. Likewise, the Centre for Pharmacy Postgraduate Education’s foundation pharmacist training pathway is mapped to the RPS programme.
In Scotland, hospital pharmacists have been able to undertake vocational foundation training since 2007, led by NHS Education for Scotland (NES) Pharmacy. In 2017, this was broadened to include pharmacists working in primary care and has since been accredited by the RPS.
Health Education and Improvement Wales (HEIW) is currently piloting a foundation programme for pharmacists, mainly in the community pharmacy sector.
In October 2019, LloydsPharmacy introduced its own voluntary, one-year foundation programme.
Why a national scheme is needed
The HEE report stated that there has “never been a defined programme for national foundation (early career) pharmacist training in England”.
“Training pathways vary both geographically and across sectors … and there is no clearly defined end point,” it continued. Pathways are also optional, and funded from different sources — through membership fees, by the company or through government funds.
The UK-wide pharmacy foundation programme, based on experiential learning and assessment, will be mandatory; once it begins, every pharmacist will be required to take it upon registration. Pharmacists who are already registered will not have to do it.
The idea has been endorsed by the UK’s four chief pharmaceutical officers and originally came from a task and finish group convened by the RPS’s faculty and education board (FEB), which is chaired by Peter Kopelman, principal of St George’s University in London.
Speaking to The Pharma ceutical Journal
in May 2018, Kopelman said the group wanted every pharmacist undertaking preregistration training to follow a foundation programme that would provide experience of working in every potential setting they may eventually work in (see Box 2).
Box 2: In quotes
“We proposed that every pharmacist following preregistration training should undertake a foundation programme on the basis that it would provide continuing development and experience in every setting that the pharmacist works.”
— Peter Kopelman, principal of St George’s University in London and chair of the faculty and education board
“We want to really develop and invest in postgraduate pharmacy training, but no one organisation can do that alone. It requires a partnership — all organisations working together to make it happen.”
— Gail Fleming, director for education and professional development at the Royal Pharmaceutical Society (RPS)
“Community pharmacists are independent contractors and the big multiples have their own training programmes. There are a lot of barriers to be broken down to sell this concept.”
— Dan Greer, programme leader for postgraduate pharmacy teaching at the University of Leeds
“Early years support is vitally important; it’s where we cut most of our clinical teeth and build our competencies … We’ve started some work in Scotland, but it would be much better to do that on a UK basis.”
— Rose Marie Parr, chief pharmaceutical officer for Scotland
“If we are going to create a sustainable, clinically orientated workforce in pharmacy, a common foundation has to happen.”
— Keith Ridge, chief pharmaceutical officer for England
“Given the urgency to secure a skilled pipeline of clinical pharmacists to work in [primary care networks], we would hope that, by March 2020, there is a clear proposal in terms of funding and an accepted training model.”
— Gail Fleming, director for education and professional development at the RPS
The proposal was then submitted as part of the RPS’s response to HEE consultation on ‘Facing the facts, shaping the future: a draft health and care workforce strategy for England to 2027’, in March 2018.
National roll out
This is still being worked out. In NHS England’s ‘Interim NHS people plan’, published on 3 June 2019, it was announced that HEE and NHS England would “explore development” of a foundation training programme by March 2020.
The RPS will launch a framework for the foundation programme on 17 November 2019, at its annual conference. The framework will set out the competencies that a pharmacist should have upon completion of the programme.
The next step for the RPS, working with stakeholders, is to design the curriculum and assessment processes. It has recently completed a small pilot of the assessment process, which is now being evaluated. The Society aims to publish details of the curriculum and assessments by the by the latter half of 2020.
An education governance oversight board (EGOB) — which includes the four UK chief pharmaceutical officers and representatives from the RPS, the General Pharmaceutical Council, NHS Education and Training, universities and employers — is tasked with overseeing pharmacy postgraduate education and training more widely.
The EGOB is expected to evolve into a pharmacy postgraduate training board. Its objective is to take the national foundation plans forward, as part of a wider plan to develop a defined career framework for pharmacists from preregistration through foundation, on to advanced practice and consultant pharmacist level.
Consistency across the UK
The RPS will develop the programme’s framework, curriculum and assessment procedures. The training programme itself will be led by HEE, NES, HEIW, and the Northern Ireland Centre for Pharmacy Learning and Development.
Although the framework, curriculum and assessments would be consistent across the UK, the way the programmes are delivered might not necessarily be the same in each of the four nations: that is decided by the four national bodies delivering the training.
Because each nation is working out its own training plans, it is unlikely that the foundation programmes will all begin at the same time across the UK.
The training will be paid for by the devolved health bodies. A spokesperson from HEE told The Pharmaceutical Journal that it has money set aside for 2019/2020 and is having ongoing conversations regarding funding beyond 2020. These conversations, it said, include consideration of the prioritisation for workforce transformation to deliver the NHS people plan.
A spokesperson for HEIW said that its current aim is to produce a feasibility plan in early 2020, which will include work on the funding model.
Anne Watson, postgraduate pharmacy dean at NES, said that “as specified within our pharmacy strategy, ‘Achieving Excellence in Pharmaceutical Care’ in Scotland, we have undertaken a review of an overarching career framework for pharmacists, which is due to report back to Scottish government by the end of ”.
“This should help shape policy for post-qualification training and recognition within a career framework for pharmacists in Scotland, of which foundation pharmacist training across all sectors is included.”
No additional funding will be set aside specifically for the foundation programme.